Associations of greenness with diabetes mellitus and glucose-homeostasis markers

The 33 Communities Chinese Health Study

Bo Yi Yang, Iana Markevych, Joachim Heinrich, Gayan Bowatte, Michael S. Bloom, Yuming Guo, Shyamali C. Dharmage, Bin Jalaludin, Luke D. Knibbs, Lidia Morawska, Zhengmin (Min) Qian, Duo Hong Chen, Huimin Ma, Da Chen, Shao Lin, Mo Yang, Kang Kang Liu, Xiao Wen Zeng, Li Wen Hu, Guang Hui Dong

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Residing in greener places may be protective against diabetes mellitus (DM) but evidence is scarce and comes mainly from developed countries. Objectives: To investigate associations of residential greenness with DM prevalence and glucose-homeostasis markers in Chinese adults and whether these associations were mediated by air pollution, physical activity, and body mass index. Methods: In 2009, a total of 15,477 adults from the cross-sectional 33 Communities Chinese Health Study provided blood samples and completed a questionnaire. We considered fasting and 2-h glucose and insulin concentrations, as well as the homoeostasis model assessment of insulin resistance and β-cell function, as glucose-homeostasis markers. DM was defined according to the American Diabetes Association's recommendations. Residential greenness was estimated by two satellite-derived vegetation indexes – Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI). Nitrogen dioxide and particulate matter ≤2.5 μm were used as air pollution proxies. Associations were assessed by two-level adjusted logistic and linear regression models. Results: A 0.1-unit increase in NDVI 500 m and SAVI 500 m was significantly associated with lower odds of DM by factors of 0.88 (95% Confidence Interval 0.82–0.94) and 0.80 (0.72–0.90), respectively. Higher greenness was also significantly associated with lower fasting and 2-h glucose levels, 2-h insulin level, as well as lower insulin resistance and higher β-cell function. Air pollution and body mass index significantly mediated 6.9–51.1% and 8.6–78.7% these associations, respectively, while no mediation role was observed for physical activity. Conclusions: Higher residential greenness appears to be associated with a lower prevalence of DM. This association might be due to glucose and insulin metabolism and pancreatic β-cell function. Lower levels of air pollution and body mass index can be pathways linking greenspace to diabetes.

Original languageEnglish
Pages (from-to)283-290
Number of pages8
JournalInternational Journal of Hygiene and Environmental Health
Volume222
Issue number2
DOIs
Publication statusPublished - 1 Mar 2019

Keywords

  • Cross-sectional
  • Diabetes mellitus
  • Glucose
  • Greenness
  • Insulin resistance
  • Mediation

Cite this

Yang, Bo Yi ; Markevych, Iana ; Heinrich, Joachim ; Bowatte, Gayan ; Bloom, Michael S. ; Guo, Yuming ; Dharmage, Shyamali C. ; Jalaludin, Bin ; Knibbs, Luke D. ; Morawska, Lidia ; Qian, Zhengmin (Min) ; Chen, Duo Hong ; Ma, Huimin ; Chen, Da ; Lin, Shao ; Yang, Mo ; Liu, Kang Kang ; Zeng, Xiao Wen ; Hu, Li Wen ; Dong, Guang Hui. / Associations of greenness with diabetes mellitus and glucose-homeostasis markers : The 33 Communities Chinese Health Study. In: International Journal of Hygiene and Environmental Health. 2019 ; Vol. 222, No. 2. pp. 283-290.
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title = "Associations of greenness with diabetes mellitus and glucose-homeostasis markers: The 33 Communities Chinese Health Study",
abstract = "Background: Residing in greener places may be protective against diabetes mellitus (DM) but evidence is scarce and comes mainly from developed countries. Objectives: To investigate associations of residential greenness with DM prevalence and glucose-homeostasis markers in Chinese adults and whether these associations were mediated by air pollution, physical activity, and body mass index. Methods: In 2009, a total of 15,477 adults from the cross-sectional 33 Communities Chinese Health Study provided blood samples and completed a questionnaire. We considered fasting and 2-h glucose and insulin concentrations, as well as the homoeostasis model assessment of insulin resistance and β-cell function, as glucose-homeostasis markers. DM was defined according to the American Diabetes Association's recommendations. Residential greenness was estimated by two satellite-derived vegetation indexes – Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI). Nitrogen dioxide and particulate matter ≤2.5 μm were used as air pollution proxies. Associations were assessed by two-level adjusted logistic and linear regression models. Results: A 0.1-unit increase in NDVI 500 m and SAVI 500 m was significantly associated with lower odds of DM by factors of 0.88 (95{\%} Confidence Interval 0.82–0.94) and 0.80 (0.72–0.90), respectively. Higher greenness was also significantly associated with lower fasting and 2-h glucose levels, 2-h insulin level, as well as lower insulin resistance and higher β-cell function. Air pollution and body mass index significantly mediated 6.9–51.1{\%} and 8.6–78.7{\%} these associations, respectively, while no mediation role was observed for physical activity. Conclusions: Higher residential greenness appears to be associated with a lower prevalence of DM. This association might be due to glucose and insulin metabolism and pancreatic β-cell function. Lower levels of air pollution and body mass index can be pathways linking greenspace to diabetes.",
keywords = "Cross-sectional, Diabetes mellitus, Glucose, Greenness, Insulin resistance, Mediation",
author = "Yang, {Bo Yi} and Iana Markevych and Joachim Heinrich and Gayan Bowatte and Bloom, {Michael S.} and Yuming Guo and Dharmage, {Shyamali C.} and Bin Jalaludin and Knibbs, {Luke D.} and Lidia Morawska and Qian, {Zhengmin (Min)} and Chen, {Duo Hong} and Huimin Ma and Da Chen and Shao Lin and Mo Yang and Liu, {Kang Kang} and Zeng, {Xiao Wen} and Hu, {Li Wen} and Dong, {Guang Hui}",
year = "2019",
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Yang, BY, Markevych, I, Heinrich, J, Bowatte, G, Bloom, MS, Guo, Y, Dharmage, SC, Jalaludin, B, Knibbs, LD, Morawska, L, Qian, ZM, Chen, DH, Ma, H, Chen, D, Lin, S, Yang, M, Liu, KK, Zeng, XW, Hu, LW & Dong, GH 2019, 'Associations of greenness with diabetes mellitus and glucose-homeostasis markers: The 33 Communities Chinese Health Study', International Journal of Hygiene and Environmental Health, vol. 222, no. 2, pp. 283-290. https://doi.org/10.1016/j.ijheh.2018.12.001

Associations of greenness with diabetes mellitus and glucose-homeostasis markers : The 33 Communities Chinese Health Study. / Yang, Bo Yi; Markevych, Iana; Heinrich, Joachim; Bowatte, Gayan; Bloom, Michael S.; Guo, Yuming; Dharmage, Shyamali C.; Jalaludin, Bin; Knibbs, Luke D.; Morawska, Lidia; Qian, Zhengmin (Min); Chen, Duo Hong; Ma, Huimin; Chen, Da; Lin, Shao; Yang, Mo; Liu, Kang Kang; Zeng, Xiao Wen; Hu, Li Wen; Dong, Guang Hui.

In: International Journal of Hygiene and Environmental Health, Vol. 222, No. 2, 01.03.2019, p. 283-290.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Associations of greenness with diabetes mellitus and glucose-homeostasis markers

T2 - The 33 Communities Chinese Health Study

AU - Yang, Bo Yi

AU - Markevych, Iana

AU - Heinrich, Joachim

AU - Bowatte, Gayan

AU - Bloom, Michael S.

AU - Guo, Yuming

AU - Dharmage, Shyamali C.

AU - Jalaludin, Bin

AU - Knibbs, Luke D.

AU - Morawska, Lidia

AU - Qian, Zhengmin (Min)

AU - Chen, Duo Hong

AU - Ma, Huimin

AU - Chen, Da

AU - Lin, Shao

AU - Yang, Mo

AU - Liu, Kang Kang

AU - Zeng, Xiao Wen

AU - Hu, Li Wen

AU - Dong, Guang Hui

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Residing in greener places may be protective against diabetes mellitus (DM) but evidence is scarce and comes mainly from developed countries. Objectives: To investigate associations of residential greenness with DM prevalence and glucose-homeostasis markers in Chinese adults and whether these associations were mediated by air pollution, physical activity, and body mass index. Methods: In 2009, a total of 15,477 adults from the cross-sectional 33 Communities Chinese Health Study provided blood samples and completed a questionnaire. We considered fasting and 2-h glucose and insulin concentrations, as well as the homoeostasis model assessment of insulin resistance and β-cell function, as glucose-homeostasis markers. DM was defined according to the American Diabetes Association's recommendations. Residential greenness was estimated by two satellite-derived vegetation indexes – Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI). Nitrogen dioxide and particulate matter ≤2.5 μm were used as air pollution proxies. Associations were assessed by two-level adjusted logistic and linear regression models. Results: A 0.1-unit increase in NDVI 500 m and SAVI 500 m was significantly associated with lower odds of DM by factors of 0.88 (95% Confidence Interval 0.82–0.94) and 0.80 (0.72–0.90), respectively. Higher greenness was also significantly associated with lower fasting and 2-h glucose levels, 2-h insulin level, as well as lower insulin resistance and higher β-cell function. Air pollution and body mass index significantly mediated 6.9–51.1% and 8.6–78.7% these associations, respectively, while no mediation role was observed for physical activity. Conclusions: Higher residential greenness appears to be associated with a lower prevalence of DM. This association might be due to glucose and insulin metabolism and pancreatic β-cell function. Lower levels of air pollution and body mass index can be pathways linking greenspace to diabetes.

AB - Background: Residing in greener places may be protective against diabetes mellitus (DM) but evidence is scarce and comes mainly from developed countries. Objectives: To investigate associations of residential greenness with DM prevalence and glucose-homeostasis markers in Chinese adults and whether these associations were mediated by air pollution, physical activity, and body mass index. Methods: In 2009, a total of 15,477 adults from the cross-sectional 33 Communities Chinese Health Study provided blood samples and completed a questionnaire. We considered fasting and 2-h glucose and insulin concentrations, as well as the homoeostasis model assessment of insulin resistance and β-cell function, as glucose-homeostasis markers. DM was defined according to the American Diabetes Association's recommendations. Residential greenness was estimated by two satellite-derived vegetation indexes – Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI). Nitrogen dioxide and particulate matter ≤2.5 μm were used as air pollution proxies. Associations were assessed by two-level adjusted logistic and linear regression models. Results: A 0.1-unit increase in NDVI 500 m and SAVI 500 m was significantly associated with lower odds of DM by factors of 0.88 (95% Confidence Interval 0.82–0.94) and 0.80 (0.72–0.90), respectively. Higher greenness was also significantly associated with lower fasting and 2-h glucose levels, 2-h insulin level, as well as lower insulin resistance and higher β-cell function. Air pollution and body mass index significantly mediated 6.9–51.1% and 8.6–78.7% these associations, respectively, while no mediation role was observed for physical activity. Conclusions: Higher residential greenness appears to be associated with a lower prevalence of DM. This association might be due to glucose and insulin metabolism and pancreatic β-cell function. Lower levels of air pollution and body mass index can be pathways linking greenspace to diabetes.

KW - Cross-sectional

KW - Diabetes mellitus

KW - Glucose

KW - Greenness

KW - Insulin resistance

KW - Mediation

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U2 - 10.1016/j.ijheh.2018.12.001

DO - 10.1016/j.ijheh.2018.12.001

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EP - 290

JO - International Journal of Hygiene and Environmental Health

JF - International Journal of Hygiene and Environmental Health

SN - 1438-4639

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